Claims management in a state of flux

The principal concern with long-term disability insuranceis to separate legitimate claims from unjustified claims. To do this, one needs extensive knowledge of medicine, law and occupational science. After all, it is first necessary to understand what practical effect a health impairment will actually have on a person's working activity in order to judge whether the disability criteria have been met. The key to this process is the definition of disability and its interpretation in law. In the USA and Canada, there are essentially three definitions which can lead to different decisions. As courts appear to be taking an increasingly consumer-friendly stance, it is important to establish a high level of legal certainty even at the stage of product development.

Orthopaedic complaints, mental problems, cardiovascular disease and cancer rank as the principal triggers of disability benefits. In some countries, mental disorders have even overtaken orthopaedic problems as the most frequent cause of disability. As mental conditions are difficult to prove, they constitute a particular challenge for risk management.

We analyse the growing significance of orthopaedics and psychosomatics in new theme-centred and interactive workshops. These workshops highlight how complex these groups of diseases are and show what sort of measures can be taken in this sphere. We also develop questionnaires specially designed for psychiatric and psychosomatic diseases and define quality criteria for reports, which have to meet certain requirements to ensure an impartialand qualified assessment of benefit claims.

Rehabilitation service is also becoming increasingly important. Experience from countries such as Canada and the Netherlands shows that rehabilitation measures can frequently shorten the period of benefit payments. Such schemes benefit both policy holders and insurers.